Hi there all, I am new to this and just wanted to see how many others have herniations at T6/7 & T7/8 with mild indentation to the spinal cord in both areas. To sum up living with this...................pain, pain, and more pain.

All due to a car accident 3 years ago, I think I am still trying to come to terms with it all........I USED to be very active, (a runner) but I know I can not do that again. :)

Mark N

06-29-2008, 03:16 PM

Flossy, I am a survivor of thoracic fusion surgery at T8-9. I currently have herniations from T4-7 and deal with it using pain meds. I wouldn't have another fusion unless neurological impairment is severe enough to warrant another fusion. Have you checked into an endoscopic surgery that could relieve the pressure of your spinal cord. This is a surgery that leaves you with 4 small incisions [I have a 14" scar from my open thoractomy] and is much easier to do. If you can't find a doctor skilled in this approach you could contact Dr Dickman in Arizona. He accepts MRIs reading them and evaluates your potential at surgery letting you know if the endoscopic approach will work for you.

I hope you come back any time you have a question, want to vent, or just want some sympathy.

Kathi49

06-29-2008, 06:22 PM

Flossy,

I am not familiar with the thoracic spine as much as Mark is. And I apologize for jumping in. But Mark, WHAT are the symptoms of a herniation vs. say the facets? I am just asking because of the spasms I have had. Yet they don't wrap around like so many others have said. If you could, could you list out the majority of the symptoms you had? Flossy, again, I am sorry but I find your post interesting (just sorry you are enduring it) and I think Mark could help us both out.

mickinuk

07-04-2008, 08:24 AM

Hi Flossy and welcome.

Those that have reported thoracic herniations here have one thing in common ... their symptoms have all been different!

I actually suffered no pain whatsoever in the thoracic region. Plenty pain elsewhere, however and lots of neuro deficiency particularly in the legs and feet and later, bowel and bladder.

The good news is that from a very low point of having absolutely no function in my legs and facing the prospect of a spending the rest of my life in a wheelchair, I have made an almost complete recovery!

Mick

nikkifrank

07-06-2008, 02:29 PM

Hi Flossie, I too have a T8-T9 herniation. Mine seems to be pressing on the cord. I do know I get the tingle prickly sensations right beside (or around) my shoulder blade. It hurts to take a deep breath...heck it hurts 90% of the time. I go to my OS on July 25th. He did my fusion at the C5-C6 level which went really well. Good luck to you.
Nikki

Mark N

07-06-2008, 07:44 PM

Kathi, I don't know what the differences are for the facet and cord other than the cord will cause loss of neurological function and I don't think the facet will do that. As Mick pointed out it seems many of us have different symptoms with thoracic spinal problems. Common problems, but certainly not the only ones, are: wrap around pains, tight band across your abdomen, heart attack pains, stabbing pains in the chest, bowel & bladder problems, simulates gall bladder attacks, on and on. I had lost all reflexes and feeling in my left abdomen and leg along with the symptoms I listed.

Kathi, I wish I could tell you the specific differences but this is the best I can do.

Tbackpain1

07-07-2008, 12:25 AM

OK, I found a great article that covers T-spine stuff very well. http://www.emedicine.com/sports/TOPIC129.HTM

It also has a section talking about the types of T-spine injuries and the 4 types of thoracic HNPs, which explains the various and broad symptomology that can present, depending on the type you have. I personally have lateral HNPs which cause nerve root compression and radiculopathy (rib pain, crushing chest pain, scapular pain, and wrap around abdominal pain). Lateral HNPs symptoms will depend on the size and at which level they are at, as to where you'll feel the pain on your body. From the article:
Location of TDHs
TDHs are generally classified into 4 categories. These are central TDHs, centrolateral TDHs, lateral TDHs, and intradural TDHs. Central and centrolateral protrusions are the most common and are found in 70% of cases. Intradural herniations are rare and are found in less than 10% of cases. Clinical presentations vary, but the following generalizations are appropriate:

Centrolateral protrusions may result in a presentation resembling Brown-Séquard syndrome, with ipsilateral weakness and contralateral pain or sensory disturbances.

Lateral herniations may cause nerve root compression, and patients may present with a radiculopathy.

Please, if you're just beginning your spiney journey, read the article. If you've got questions, post em here. I'll be glad to answer them to the best of my ability. Between the bunch of us T-spiney's, we pretty much cover the gamut of the various presentations, and depending on those presentations, we've had different treatment routes and/or surgeries.

http://www.emedicine.com/sports/TOPIC129.HTM

Kathi49

07-07-2008, 07:10 AM

Thank you Mark and Theresa,

The ONLY pain I feel right where my bra strap is is sometimes a "catch". It is hard to describe. And then the pain or spasms just radiate out but they don't wrap around although sometimes it feels like my rib cage hurts. Anyway, nothing goes to the front or in the chest. Both PM's I have feel pretty confident it is the facets simply because I told them what triggers it and it is usually if I bend down to pick something up or put something down that is awkward. I just wish they would do an MRI of the thoracic area so I would know. God knows everything else in my body has had at least one MRI! :eek::D But, no, no deficits that I can tell, no heart pains or anything similar. And it just comes and goes...not an every day thing. Anyway, thank you both for the information so I will know what to watch for.

Mark N

07-08-2008, 01:50 AM

Kathi, your pain descriptions are describing facet problems or herniations that compress nerves as they exit at that level. Most doctors won't do the MRI unless they are looking at surgical solutions or trying to find the source of pain that they will treat. I have had way too many MRIs but I understand your curiosity and concern.

artchick

07-09-2008, 03:55 PM

Hi Flossy and everyone else-

It's been a while since I've posted here, unfortunate to see so many more with T spine issues. Flossy-I have had T5-8 protusions and herniations for four years-I live on meds, icepacks, PM and ESI's, recently added T3 herniation and L4 and 5 large herniations with stenosis and forminal whatever-closing of the nerve outlet- anyway-I completely empathize with your pain. If considering, ESI's will work for facet pain-problem for me-was that they did not work for long, at least not compared to cost. I was very excited the first Lumbar ESI-as immediate relief from leg pain!!! However, sneaky pain came back within a month or so-for others an ESI can last a vevy long time. Should check it out if pain persists and is due to facet problem. Other than that-glad to see you online and getting the support that we all need-so hang in there and keep posting.

Best Wishes-

Artchick

suede

07-10-2008, 01:20 AM

Yep all 3 levels of the spine, in the T spine T5/6, T6/7, T8/9, sure make life tough.
Welcome to BT so sorry for your need to be here.
Linda

Judy4

07-10-2008, 02:14 PM

Hi,
It seems like there are a lot of you who choose not to have thoracic surgery. I need to be out there hiking a lot, with the pain my thoracic spine causes, I would have to be on heavy pain meds to do that.(If it is possible) If fusion can be done posteriorly ,please let me know why no one is choosing to do this.
Thanks
Judy

Tbackpain1

07-10-2008, 06:44 PM

Judy,

From everything I've read in the medical research journals, there are a couple of factors that limit the viability of posterior only fusions. First, its a question of what part of the T-spine you have to access and where exactly the patient is experiencing their problems. Second, those with scoliosis complicating things have much higher successful outcomes with global procedures, especially when they have Lenke 1 curve patterns. Then there's the instrumentation itself...it varies from surgery to surgery, whether its one kind of rod/screw construct or a dual rod/hook/screw combo. In order for fusion to be successful, there has to be a rigid structure to support the spine...posterior alone would be like only having half a zipper. You need both anterior and posterior stabalization to give you the most support possible.

There are MANY factors that go into the decision to have one kind of surgery over another. Ultimately, its between the surgeon and the patient. Thoracic specialists are pretty thin on the ground, and just because your surgeon has done other spinal surgeries does not mean he/she is qualified to do T-spine surgery. There are many things in T-spine surgery that one would not encounter in other areas of the spine (rib articulations, MAJOR organs, other anatomical structures).

The biggest thing I can tell you is that one does not, under any circumstance, under go spine surgery for pain relief alone. For T-spine surgery, unless you are experiencing neurological defecits, any ethical surgeon will tell you to wait. The risks of surgery are high, and no guarantee that you won't be in the same or worse condition afterwards. I've consulted with three of the leading T-spine surgeons myself, in the hope that something could be done...I started this spine stuff at age 21, so my life is far from over. But surgical intervention is not the end all, be all. Management of pain, strengthening of core muscles and good coping techniques allow me to continue living a full life. But, I'm not out hiking to camp sites fully loaded with gear anymore, nor can I rock climb or mountain bike...risky activities for any spiney.

Basically, the rate of failure is higher with posterior only procedures. Global (Anterior/posterior) have the best outcomes. There are some newer techniques that access the spine laterally, using thorascopic techniques, but that's more for discectomies than fusions. Research, research and research some more. Dr. Curtis Dickman at Barrow Neurological Institute in Phoenix, AZ ; Dr. John Regan http://www.spinesource.com/Back-Pain-Disorders/thoracic-disc-herniation.html ; Dr. James Farmer at Hospital for Special Surgeries NY, NY are the top docs for T-spine and have been innovators in the use of VATS (video assisted thorascopic surgery).

Theresa

Judy4

07-10-2008, 07:24 PM

Theresa,
Thank you so much for your knowledgable answers and explanations. I already looked at Dr. Regan's site. He is local for me as I live in Los ANgeles. That was exciting for me.
I have an apt with my spine surgeon on July 21st. I am no where near ready to return to the hospital as I just had hip replacement surgery. I just want to see what he has to say as the epidurals in the thoracic area haVe not done much. The last time I saw him he wanted to wait until after the hip has healed to see how things are then.
But, my neck has really been bothering me and I think I am still taking heavy duty pain meds for my neck and back verses my hip!!
Just a mess!!!!
Judy in So Cal

Mark N

07-10-2008, 07:48 PM

Judy, if your doctor recommends having a thoracic fusion please get another opinion [Dr Dickman in AZ would be my choice out west] to verify what your doctor is saying.

I have been through a thoracic fusion and based on my experience I won't have another one unless I have neurological impairment that requires another one. I had severe impairment before my last one and based on the surgery and recovery I wish I could have put it off longer.

Theresa has given you very good info about the danger. I can tell you that going in with the idea of taking a posterior approach doesn't guarantee that you won't have an open thoractomy. One of our former members and part of T-Park on Yahoo went to Dr Dickman [he is one of the leading experts for endoscopic thoracic fusions] for an endoscopic approach and woke up from surgery with an open thoractomy. As Dr Dickman got into the surgery he found the damage couldn't be taken care of unless an open thoractomy approach was taken.

There are no guarantees going into spinal surgery but especially with thoracic fusions because so much of our core body is involved with most of the fusions. As Theresa pointed out, other approaches have higher rates of failure so that balances out the risk of an open thoractomy.

For me it boils down to this, I have had one thoracic fusion and with more thoracic herniations I will continue to avoid another fusion as long as my neurological functions don't become too impaired.

suede

07-10-2008, 08:57 PM

Judy,
I haven't had a chance to read the other replies so If I'm repeating sorry.
If you have any Dr tell you that surgery Will cure or stop your pain and you'll be fine then run like **** and get more opinions, any back surgeon that is worth having will be honest and tell you that back surgery is not a cure for pain, it is most commonly done for neurological problems and stability.
I'm not trying to be cruel just honest, in all the years I have been posting and reading on forums I can not tell you how many went in to surgery with the belief that they would be pain free or real close.
At times it works out that it does help with the pain but not always and I don't believe often.
With problems at all three levels I can honestly say for me it is the T spine that scares me the most.
It's great to see that you are wise to be out researching, knowledge is power.
Linda

Judy4

07-10-2008, 10:56 PM

Mark and Linda,

Thanks for all the points you have brought up. I really hadn't thought out the chance of going in for one type of surgery and ending up with something totally different.

I just had running (which has been my passion) taken away from me. To give up hiking due to pain at this point is not a possiblilty with me. I would go crazy with no escape. Of course a fusion that did not work won't help me either!!!
Thanks
Judy

Mark N

07-10-2008, 11:16 PM

Judy, I was very active and loved my teaching/coaching career. I thought losing out on lifting weights would drive me crazy but I found that I needed to treat my pain so I could get to work the next day. I didn't even miss my training and lifting the way I thought I would. the reality of my spinal condition just made those activities out of the question. The hardest thing has been giving up things I loved doing especially as I became totally disabled. It is a grieving period that we go through and we can only do it one stage at a time.

If it were a lumbar or cervical fusion I would say have it before you give in to a life of pain and disability. A thoracic fusion is too tough to take that kind of chance in my mind. It doesn't hurt to research and get several opinions from qualified doctors. Take your time and make a decision that you can live with but don't forget that any fusion can leave you with disasterous results. Sandi on this board went in for a lumbar fusion that many of us have had great success with but come out without the ability to urinate and is now in a wheel chair. None of us plan on bad results but I think we need to factor them in before undergoing a spinal surgery. I wish you the best whichever direction you take.

Judy4

07-11-2008, 01:13 AM

Thanks Mark,
you just brought up another problem , the disastrous outcome.
I guess right now in the recovery from the hip replacement, I am feeling so limited in activity, I want to recover and be able to do things again. It is depressing to have my back hurt every morning and remember it will intefere.
I had a 3 level cervical fusion last summer. In the last month it has reallybeen bothering me. As soon as 4 hours is up , my hip is still ok, but my back and neck want more meds.
Is that what people do with thoracic problems, just stay on pain meds??

I will continue investigating this thoracic issue. I know you have sent me the name in Az., someone else gave me the info on Dr. Ragen(sp?) who is in Los Angeles as I am . I will start with him.

Thanks again
Judy

Mark N

07-11-2008, 07:16 AM

Judy, most people with thoracic pain do treat it with pain meds and muscle relaxers. A lot of the equation is your quality of life. As limited as my life is now, from continued spinal deterioration, I couldn't trade my life with the life I could have that maybe much worse. Granted we never go into a surgery thinking we will be worse afterwards. Many lumbar and cervical fusions are very successful, even though they can go bad, but the vast majority of thoracic fusions have a greater lasting impact.

It is good that you are checking out Dr Regan and I hope you will send your films to Dr Dickman in AZ as he will read thoracic films and give you a recommendation. Those two doctors should give you a better idea of your choices.

Judy4

07-11-2008, 11:34 AM

Hi Mark,
Today I woke up with a lot more discomfort from my back and neck. I have been taking 2 percocet when I get up . I am trying one to see what happens. I am not comfortable sitting or laying down!!
Usually flat on my back on the floor works for a little while. I have hip restricions so I cannot get on the floor!!!

I went swimming the last 2 mornings. I haven't done that for exercise in many years. Do you know if swimming aggrivates the thoracic area. I know it kills my neck, good for my hip though!!

Thanks
Judy

Nana4&cntn

07-11-2008, 04:17 PM

Judy, my mom has problems with her neck and uses a snorkle and goggles. This prevents her from having to twist or raise her neck to breathe, she just keeps her hed in the water. I have tried it and it takes some getting used to, especially if you have been a distance swimmer. Hope this helps:)

Take care,
Kathy

Mark N

07-11-2008, 04:32 PM

Judy, Depending on the stroke you use or if you use a kick board to work your hip, swimming shouldn't put undue pressure on your T-spine. Our T-spine is supported and protected by our ribs so unless you over stretch or twist at the waist you shouldn't have any trouble. If you develop thoracic pains then you know to stop swimming that stroke but I would try and find another stroke that would work. I hope it works out for you as it would do wonders for your hip.

Judy4

07-11-2008, 07:54 PM

Kathy and Mark
Thanks again for your responses.
I guess even though I am not doing much in the pool. My body today was exhausted. I came home and layed down to get the water out of my ears and the afternoon was history.

Kathy,
My husband asked me if they would let me use a snorkle in the pool last night. Good plan.

I tried to keep my head underwater and did the sidestroak for awhile, but I cannnot even find a halfway comfortable position for my neck now. I just gave in and took pain meds.

Mark,
I was watching some swimming on line before I went. I did not see the sidestroke yet, but that definately causes some discomfort. The crawl seems to be moving your whole back together. I may have to get a swimming instructor to tell me what I am doing wrong. After I see the Docs in the next week.
Judy

lucidmaster

07-15-2008, 07:50 PM

Hi All,

I have a different opinion on thoracic surgery in the presence of cord related pain. The reality is that thoracic issues, if they have been around for some time, will NOT go away, and only get worse with time, especially if you try to keep active to some degree, as the symptoms are somewhat masked with pain killers and other medication. Pain is usually the first symptom. If pain is cord related, meaning if it is experienced away from the thoracic area, there is a very high chance that you will eventually develop neurological deficit. I would have thoracic surgery in the presence of cord symptoms even if they are not serious in order to keep things from getting serious, but you MUST do your research and find an experienced surgeon who has done many thoracic surgeries without complications.

If you develop cord related neurological symptoms, there is a very high chance you won't recover well. The spinal cord is not particularly good in repairing itself, and doctors/medicine can't fix it once it's damaged. The extent of potential recovery is directly correlated with the duration of symptoms. The more you wait, the lower your chances of recovery. The problem is that surgeons are kind of cornered in this country because of liability issues, and they don't want to operate on someone who doesn't have severe issues because they don't want to risk their career being ruined if something goes wrong during surgery.

As a scientist (in a non-medical field), I completely disagree with this approach. Anterior thoracic fusion surgery is very painful/hell, but if it is done by an excellent surgeon, the risks are not high as people claim they are although they clearly exist. Based on everything I learned while doing my own research, I came to the conclusion that the risks of waiting are higher in the presence of cord symptoms. Most of the doctors I saw disagreed, and I had to leave the country to get treatment although one was finally willing to do what was necessary, but it was too late. I am really glad I had the surgery as I would most likely have lost bladder control for good by now if I hadn't done so. I still have many issues, but I am better than I was before surgery. My only regret is following the advice of many doctors who told me to wait. Some highly respected doctors even told me my issues had nothing to do with my thoracic herniation without being able to offer me another explanation.

Having said all this, when issues are not very serious, one cannot justify such major surgery--intellectually or emotionally. It seems so irrational to have your chest cracked open because of leg/groin pain. Even when issues became serious, I still could not believe what was happening to me as I watched the corridor ceiling go by in a hospital bed, on my way down the operating room. That I might not open my eyes again, and that that might simply be it. It is really scary. But, based on everything I've learned, I believe it is what needs to be done when you have cord symptoms...

Of course, there are exceptions to this. If you have many spinal issues, and a single surgery might not help then the decision process is much more complicated. And, you must be in good health to tolerate the thoracotomy.

-Ozgur.

Judy4

07-15-2008, 08:36 PM

Ozgur,
Thank you for your point of view. My thoracic issues have gotten worse in the last year and a half. They now impact my life most days. I have an apt with my surgeon next week to begin the discussion of surgery.
Last ear it was easy to make the cervical surgery decision as I deteriorated in abaaout 6 weeks.

Thanks again,
Judy

lucidmaster

07-15-2008, 10:58 PM

Yes, that's often the case with thoracic issues. Since that area of the spine is very stable due to the ribcage and the ligaments, things usually don't get worse all of sudden unless there is severe direct trauma or a sudden major herniation. Progression of the symptoms is often very gradual.

To answer you previous question about posterior fusion: it all depends on the location and size of the herniation. Posterior approaches are a piece of cake when compared to the thoracotomy in terms of post-op pain. I had one and walked out the hospital the next day. But they couldn't get at the herniation as the the disc is on the other side, and the spinal cord is in the way. They can't and shouldn't try to move the cord. The surgeon who did that surgery was wise and did not risk things to that extent. It was worth a shot regardless. I have heard of less experienced surgeons trying too hard during posterior surgery, and damaging the cord in the process. That type of injury during posterior surgery is also well documented in the literature. But again that all depends on the size and location of the herniation.

Good luck.

Mark N

07-16-2008, 07:12 AM

Judy, I have to say I agree with LucidMaster if you are having neurological deficits. I know my surgeon rushed me into surgery once mine changed from pain to losing functions. I remember him saying that he does patients from around the country and he couldn't believe that other surgeons made people suffer the way they do with thoracic pain. Now this is the same surgeon that wants [just like I want] to treat my current thoracic issues with medicine as I have no cord compression symptoms. I think that is the dividing line between surgery and pain meds.

The biggest key, if surgery is needed, is to find the right surgeon that is qualified and has the experience to do the surgery. As I have said it is a more difficult surgery than other spinal surgeries because they do go into your chest cavity unless you have the posterior approach or the endoscopic approach. As LucidMaster said you have to be ready for all the consequences when they are wheeling you to the OR. I am sure I waited too long before seeing my surgeon but it did make it so I knew there was no other choice for me.

Judy4

07-16-2008, 01:03 PM

Mark,
That is the same thing that happened last summer warranting my cervical surgery. It went from pain in the neck , loss of range of motion, arm pain, tingling numbness, muscle weakness in a very short time frame.

What are the neurological problems in the thoracic spine. I have for the last couple of years had the wrap around pain that feels like a heart attack. Thankfully they are not an every day occurance. Of course the tingling/numbness feelings. Ribs are very uncomfortable. Pain (which I know does not count as much) so bad I have to lay flat on my back on a hard surface. (not possible now do to hip restrictions) I have nausea issues which my gi doc does not see a cause for. I had read that the thoracic nerves do affect the stomach and have wondered if they could be causing that. Any twisting motion really aggravates things.

I do think I am more miserable now as it is a combo of neck,hip and thoracic. As I am sitting here trying to decide what med to take, I thought of a dream last night where I was saying that I am sick of taking pain meds and the way they make me feel!!!
Of course in the dream I could barely see, everything was through a cloud!!

Time for the last cup of coffee and the percocet, vicodin, darvocet,over the counter decision.

Judy

Mark N

07-16-2008, 05:05 PM

Judy, I had intestinal problems, complete loss of feeling on my left side, loss of all reflexes in my left knee and ankle, along with bowel & bladder problems. I had been dealing with all the pains such as heart attack, wrap around pains, feeling of a tight band around my abdomen, pains shooting through my rib cage, etc.

You are having enough problems that I would consider a fusion but on the other hand I am currently dealing with bowel problems, heart attack pains, wrap around pains, etc and dealing with it using pain meds and muscle relaxers. It is a decision that only you can make. I go the pain med route because another fusion would be total disability which I am now anyway. Why take the risk or spend the money as I can control a lot of my pain by control my activity.

lucidmaster

07-16-2008, 07:26 PM

Judy,

It's very simple although some doctors will come up with their own theories and complicate things. If you have a herniation putting pressure on the cord, anything at or below that level can be affected. Any muscle or sensory tissue for instance. There usually are no patterns, and things seem pretty random at first. As Mark pointed out your bowels can be affected. Your bladder, reproductive organs, leg/hip/thorax muscles can all be affected. Numbness is also not a good sign and can mean nerve damage.

My very first symptom was very localized sporadic pain in a part of my abdomen. They thought there was something wrong with one of my organs and ran a bunch of blood tests and urine tests, and concluded I had strained that muscle. I told them ten times that I had not and I would have known if I had because I used to be an athlete and know my body, but they just dismissed it and sent me home. Two years later, when the herniation was finally discovered, they still kept on telling me it was nothing, and there was no reason for me to lie on the couch all day as opposed to riding my bike for several hours a day. I was told to lift weights like an olympic weight trainer by a Harvard professor...

If the pressure is on an exiting nerve root only, then you might have local symptoms in your thorax only without feeling anything below that area such as your legs.

-Ozgur.

Judy4

07-16-2008, 07:48 PM

Mark,
Are you still experiencing symptoms due to new involved levels or is it the fusion you had not working?
Certainly if bowel or bladder was affected the decision would be easy for me.

If I can control everything with pain meds and still stay active that would be ok. The problem lies in me having to give up things I do .

You said you were not considering surgery as you are already totally disabled. Is that with your ability to function. Do you feel it would be worse with more surgery?

Ozgur
Sorry if I got the spelling wrong. Thaks for your info on nerve involvement. It is much more of a challenge, as you know, finding info on the thoracic
area.

I really appreciate everyone's effort to help me. Of course I am just beginning to possibly consider surgery.

Judy

Mark N

07-18-2008, 12:56 AM

Judy, My fusion was a success and I returned to work for several years. My disability is due to chronic pain due to further deterioration of my disk and the pain from the car tissue that developed. Yep, bowel and bladder issues are a good reason to go ahead with the surgery but they can't pinpoint the cause of my nerve damage that causes my current bowel problems. I had been having spinal surgeries every three years and frankly got tired of the surgical merry go round.

My disability would be just as bad since my doctor had said the next spinal surgery would totally disable me due to the condition of my spine. As much as I don't like my limitations I know that things can get much worse following surgery and it isn't worth the risk to me. If I had one area that could be pinpointed for my problems then I would be looking at more surgery unfortunately it is the combination of more levels being involved and the effects of previous surgeries. I had so much scar tissue built up from my lumbar fusion that OSS couldn't put the morphine drip in following my thoracic fusion the way he wanted to because scar tissue wouldn't allow him to insert it.

The problem with thoracic fusions is even if successful they will leave you with some limitations. So you go in to improve your symptoms and the improvements come with a price from many of us. I never felt limited with my lumbar fusion after I recovered but I can't say the same about my thoracic fusion. There were many things I couldn't do any more following my thoracic fusion but I could do much more than what I could do before my fusion. You have plenty of reason to pursue a fusion just know that there are likely to be linger effects from the surgery itself. If you are able to have the posterior approach those effects will be limited.

Judy4

07-18-2008, 01:25 AM

Mark,
I am sorry about your situation. Every time I hear from you , I learn new things. Scar tissue is an issue I never thought much about.

I know from my cervical fusion,my limitation is in range of motion. But 2 doctors pointed out that due to pain , I was already limiting my motion without knowing it.

Me having 2 major surgeries in 10months, I am in no way ready to have more even if there was a guarantee of success!!
Yes, I must see what I would no longer be able to do if I were fused. Also see what is going on with my neck.
Tomorrow I have my 6 week post apt with my hip surgeon (speaking of limitations) I am wondering if he will lift any of my restrictions in movement.

I am thinking on Monday my spine doc will probably suggest I try injections one more time. My thoracic area really caused pain when I was washing dishes today. Maybe I should be banned from doing that!!
Thanks again
Judy

lucidmaster

07-18-2008, 08:51 AM

Judy,

As Mark is saying, when multiple levels are involved, it can be difficult to pinpoint the cause. They have hard enough of a time pinpointing things with a single level compression. If you just recently had surgery, I doubt that they will want to operate so soon without seeing how much benefit you will see from it first. In another words, they will most likely suggest waiting for a year to see if you improve overall.

Even if you have thoracic surgery, you will never be the same again. As Mark is saying you will most likely be better than before, but it is unlikely that you will recover fully. Mick seems to be an exception there. My point is to consider the risks of not having surgery with your doctors because things can and usually do get worse, and that can be stopped. The only cases of full recovery I've heard of are people who had an accident, developed neurological deficit, and were immediately operated on. Again, the duration of symptoms seems to determine the extent of potential recovery.

Best,

-Ozgur.

Judy4

07-18-2008, 01:13 PM

Ozgur,
I agree with you on the duration of symptoms being tied in with amount of recovery. I had read the same last year before my cervical surgery.

My spine surgeon is the first to have recommended getting my hip replaced first to see if that helped with gait, then thoracic pain.
I would have waited longer to see him, except my neck has been bothering me a lot. I am hoping a level below the fusion has not deteriorated.

Of course , my thoracic spine has not liked the sleeping position I must be in for the hip to not dislocate. I have to discuss pain meds for that. I wake up in pain all over my body, not sure which is worse. It may be that my cortisol is low again as I have major endocrinology problems. They actually sped up the degeneration process and also caused bone density problems.

I just read through an old thread on thoracic herniations. Lots of good info from you guys. I know you mentioned the posterior approach was successful for certain direction of disc problems.
From my MRI I have 3 anterior bulges. One also has a posterior. One is a diffusely bulging and scoliosis.
Are there any that sound like posterior would be impossible? Also asymmetric disc space narrowing.

Thanks
Judy

Mark N

07-18-2008, 04:46 PM

Judy, of course you should use your thoracic pain as a reason to not do dishes:D. Really, to have the least amount of pain you do need to eliminate the activities that cause immediate pain and continue to do the things that don't cause immediate problems.

lucidmaster

07-18-2008, 11:15 PM

Ozgur,
I agree with you on the duration of symptoms being tied in with amount of recovery. I had read the same last year before my cervical surgery.

My spine surgeon is the first to have recommended getting my hip replaced first to see if that helped with gait, then thoracic pain.
I would have waited longer to see him, except my neck has been bothering me a lot. I am hoping a level below the fusion has not deteriorated.

Of course , my thoracic spine has not liked the sleeping position I must be in for the hip to not dislocate. I have to discuss pain meds for that. I wake up in pain all over my body, not sure which is worse. It may be that my cortisol is low again as I have major endocrinology problems. They actually sped up the degeneration process and also caused bone density problems.

I just read through an old thread on thoracic herniations. Lots of good info from you guys. I know you mentioned the posterior approach was successful for certain direction of disc problems.
From my MRI I have 3 anterior bulges. One also has a posterior. One is a diffusely bulging and scoliosis.
Are there any that sound like posterior would be impossible? Also asymmetric disc space narrowing.

Thanks
Judy

If you type the entire MRI report here, we might be able to say a few things about it. But the language in the reports can vary depending on who is prepearing them. Ultimately, your surgeon will study the actual images and make a determination.

If you are dealing with multiple potential pain generators, it might be difficult the assess how much the thoaracic issues are contributing. You should bring that up with your surgeon to see what he thinks.

Judy4

07-19-2008, 12:16 AM

Thanks again Ozgur. My surgeon is aware of my other health issues, we have kknow each other for a while. I have had lumbar and thoracic blocks done by him as well.
Her is the MRI discussion although I am not totally confindent in their findings as my hip arthrogram was all wrong.

Findings; THere is a thoracolumbar dextroscoliosis centered at the T10-T11 level. there is secondary asymmetric disc space narrowing in the mid and lower thoracic spine.

Anterior disc bulges are present at the T6-T7, T7-8 and T8-9 levels. A small right-sided posterior disc protrusion is also noted at T8-T9 which is not impinging on the spinal cord or the exiting nerve roots. A diffusely bulging disc annulus is present at T10-T11.

The remaining disc levels are unremarkable. The intervertebral foramina are normally patent.
No signal abnormalities are present within the spinal cord, vertebral marrow spaces or paraspinal soft tissues.

I did a few twisting hard falls (when trying to cross country ski ) this past march about 6 months after the mri was taken. I did brake some ribs although a bone scan did not show any spine fractures.
I see my doc on monday

Judy

Mark N

07-19-2008, 04:41 AM

Judy, I would think that your broken ribs could be accounting for the muscular pains. It is possible that you falls did more damage but since the disk problems are anterior it would be difficult to use a posterior approach to a thoracic fusion.

Twins is another one that just had a thoracic fusion the past year and she has had a great recovery. Her fusion was a result of a car accident and the surgery was done right away. As Ozgur has pointed out, these cases seem to have the best results and Demi [Twins] is no exception. You could go back and read her post to see how good a thoracic fusion can be.

lucidmaster

07-19-2008, 09:33 AM

Judy,

Based on your report, most of the bulges are to the anterior of your spine. I think that means they are actually on the other side of your spine, pointing toward your internal organs. I don't think that causes any significant pain although there are some nueral structures around the spine in that area as well, but my anotomy knowledge is limited in that regard. So, it doesn't sound like you have a disc herniation that is compressing your spinal cord or a nerve root. That's a good thing. That explains why you don't have any cord related symptoms.

But it does sound like you have scoliosis, and your doctor will need to tell you if it is severe enough to be causing pain.

In other words, there is nothing alarming about your report as far as I can tell, and if you don't have any cord related symptoms, I doubt that your surgeon will suggest surgery unless he wants to treat your scoliosis.

Best,

-Ozgur.

Judy4

07-19-2008, 03:09 PM

thanks Ozgur,

The last time I saw my surgeon, he mentioned fusing the whole thing, which is why I started researching. I do hava the wrap around heart attack pain, numbness, tingling, intense pain when walking, hiking etc where I have to lay flat on my back to get any relief.

Actually in the last month I have been worried about the neck to upper back pain. I just read someon's post talking about changes after ACDF. I had a 3 level one last summer and things have progressively gotten worse. Monday will tell!!!
thanks again
Judy

Tbackpain1

07-19-2008, 07:42 PM

Hey Judy,

I'm not sure if you saw this link...I posted it in another thread that you had posted in. http://www.emedicine.com/sports/TOPIC129.HTM Please give it a thorough read, as it should answer some of the questions you're having about what you're experiencing and what to expect. Here's another link that has some info specifically about the surgical techniques used: http://www.spine-health.com/conditions/herniated-disc/thoracic-disc-herniation-treatment Just scroll toward the bottom for the surgical information.

I can only comment on one other thing that may be causing some of the pain you're having. The asymetric disc space may be causing some of the pain, because the asymetry may be placing pressure on your discs. Also, a diffusely bulging disc annulus at T10-T11 could be the cluprit for some of you pain, because the outer third of the anulus fibrosis is innervated by the sinuvertebral nerve, which relays sensory information, including pain, to the dorsal root ganglion. Tears in this region, particularly radial tears, may be clinically significant.

Good luck at your appointment.

Theresa

Judy4

07-19-2008, 09:08 PM

Hey Theresa,
I did see those articles before, thanks
I have been very fortunate as my hip surgeon has kept me supplied in pain meds. I might have gone crazy without them. I can always tell when 4 hours has gone by , my neck and upper back now tell me first.
thanks again,
Judy

lucidmaster

07-20-2008, 09:51 AM

thanks Ozgur,

The last time I saw my surgeon, he mentioned fusing the whole thing, which is why I started researching. I do hava the wrap around heart attack pain, numbness, tingling, intense pain when walking, hiking etc where I have to lay flat on my back to get any relief.

Actually in the last month I have been worried about the neck to upper back pain. I just read someon's post talking about changes after ACDF. I had a 3 level one last summer and things have progressively gotten worse. Monday will tell!!!
thanks again
Judy

Judy,

I would ask him what he thinks is causing your pain and what fusing your entire thoracic spine would change. Then I would ask the same questions to another surgeon to see if they are saying similar things. Not that this is a bulletproof method or anything, as they often say different things, but it would be good to get another perspective.

I would also ask him if your cervical issues might be causing your thoracic symptoms. If your cord was directly under pressure in your neck, you can have all sorts of symptoms at the levels below.

Let us know how it goes.

Best,

-Ozgur.

Judy4

07-20-2008, 01:12 PM

Thanks Ozgur,
He had told me things radiate down , but not up. At that time, the neck was behaving, fused, ok. This is the first time I will be telling him about how bad the neck has gotten. I thought once it was fused, that was it. I don't regret doing it , it was in horrible shape. I had gone to a surgeon in LA that my mother in law (step) really wanted me to see as her son in law is the head of neurosurgery at a LA hospital and said this doc was the best. He told me I did not need cervical fusion in the next half hour, but needed it soon.

The thoracic pain I get now, walking, hiking,washing dishes, I realize I have gotten for over 25 years, it has just got progressively worse the last 2 years. I remember buying our first house. The previous owners had redone the kitchen, the counters were abnormally high and it was the first time I did not have pain doing things in the kitchen!!
Maybe it is the scoliosis.
I'll let you know tomorrow.
thanks so much
JUdy